Rapidly shifting U.S. demographics are fueling the urgency of civil rights leaders, social scientists, policy makers, and public health professionals to focus their attention on policies designed to close the gap in racial and ethnic health disparities and ensure justice and equity in communities of color. In the interest of social justice, the good intent of policies developed and endorsed by dedicated public servants requires, however, a thorough and thoughtful consideration of the impact of unintended consequences of those policies in communities of color across the nation.
While many Black Americans have made significant advances in professional and educational achievements, heightened political and social status, far too many are still burdened with poverty, few employment and educational opportunities and poor health. Compounding this situation is the tense relationship between police and the Black community because of use of excessive force, profiling, over incarceration, and selective prosecution. It has also been well documented that Black people are sicker, experience bias and discrimination in the healthcare system and die sooner than other groups in American society.
It stands to reason why conscientious policymakers and public health professionals are zealous in their efforts to do whatever it takes to improve the safety, quality of life and health in Black communities-even if it means making selected harmful products unavailable by imposing bans and prohibitions.
Prohibitions and bans are official public proclamations and legislative orders forbidding, limiting, restricting and making illegal a behavior or forbidding, limiting, restricting and making illegal the use, manufacture or selling of a product. In 1920, Congress ratified the 18th Amendment to the Constitution prohibiting the manufacture, transportation and sale of liquor.
The good intentions of those who aggressively supported the prohibition on alcohol were to reduce access to alcohol as a way of reducing drunkenness, the crime and accidents caused by drunkenness and to reduce the death, illness and disease associated with the use and abuse of alcohol.
The national prohibition of alcohol (1920-1933) was extremely difficult to enforce. While the consumption of alcohol dropped at the beginning of the period, its use subsequently increased. Banning alcohol did not stop its use. Unregulated, illegally produced alcohol was more dangerous to drink, crime increased and became “organized,” courts and prisons were stretched to the breaking point. When the production and sale of alcohol went underground, black markets developed controlled by the Mafia and gangs in communities. By 1933, public sentiment had turned against prohibition and Congress repealed the act by constitutional amendment. The unintended consequences of alcohol prohibition were real and far outweighed the good intent of the prohibition and led to the failure of this noble experiment.
The lessons learned from the failed policy of alcohol prohibition are important for us today when a ban on menthol cigarettes has been proposed to reduce smoking among African Americans. Since more than 80 percent of African Americans who choose to smoke, smoke menthol cigarettes, prohibitions, restrictions and bans would affect Black communities more than other communities in America.
When police have to spend time enforcing prohibitions and bans, they have less time to focus on solving violent crime and ensuring public safety. Tensions between police and the Black community have focused national attention on the pervasive inequities in the U.S. criminal justice system. In 2014, the National Research Council issued a comprehensive report on America’s overgrown criminal justice system. The rate of imprisonment in the United States has more than quadrupled during the last 40 years. The U.S. prison population is largely drawn from men under age 40 and mostly men of color. The Council found that high incarceration rates came about not because of an increase in crime, but because of policy choices. A menthol ban could make a bad situation in the criminal justice system worse for Blacks.